Provider Demographics
NPI:1982048773
Name:QUINN, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:QUINN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2227 LYNN AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:WI
Mailing Address - Zip Code:54720-1553
Mailing Address - Country:US
Mailing Address - Phone:715-839-6559
Mailing Address - Fax:
Practice Address - Street 1:317 S 2ND ST
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:WI
Practice Address - Zip Code:54610-7700
Practice Address - Country:US
Practice Address - Phone:715-839-6559
Practice Address - Fax:715-285-5937
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI129040-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI129040-121OtherSTATE OF WISCONSIN